The effects of demographics, functioning, and perceptions on the relationship between self-reported and objective measures of driving exposure and patterns among older adults.

The exploratory study reported here was intended to examine: how strongly subjectively reported driving avoidance behaviors (commonly referred to as self-regulation) and exposure were related to their objectively measured counterparts and whether it depended on the specific behavior; the extent to which gender and age play a role in the association between subjectively reported driving avoidance behaviors and exposure and their objectively measured counterparts; and the extent to which demographics, health and functioning, driving-related perceptions, and cognition influence the association between subjective and objective driving avoidance behaviors overall. The study used data from the Longitudinal Research on Aging Drivers (LongROAD) study, a multisite, prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental, and technological factors in driving safety during the process of aging. Objective driving measures were derived from GPS/datalogger data from 2131 LongROAD participants' vehicles. The corresponding subjective measures came from a comprehensive questionnaire administered to participants at baseline that asked them to report on their driving exposure, patterns, and other aspects of driving. Several other variables used in the analyses came from the comprehensive questionnaire and an inperson clinical assessment administered to participants at baseline. A series of simple linear and logistic models were fitted to examine the relationship between the subjective and objective driving measures of interest, and a multivariable analysis was conducted to examine the potential role of selected factors in the relationship between objective and subjective driving avoidance behaviors. Results of the models are presented and overall findings are discussed within the context of the existing research literature.

Self-reported health conditions and related driving reduction in older drivers.

We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study's baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.

Average vs item response theory scores: an illustration using neighbourhood measures in relation to physical activity in adults with arthritis.

OBJECTIVES: Our study had two main objectives: 1) to determine whether perceived neighbourhood physical features are associated with physical activity levels in adults with arthritis; and 2) to determine whether the conclusions are more precise when item response theory (IRT) scores are used instead of average scores for the perceived neighbourhood physical features scales. METHODS: Information on health outcomes, neighbourhood characteristics, and physical activity levels were collected using a telephone survey of 937 participants with self-reported arthritis. Neighbourhood walkability and aesthetic features and physical activity levels were measured by self-report. Adjusted proportional odds models were constructed separately for each neighbourhood physical features scale. RESULTS: We found that among adults with arthritis, poorer perceived neighbourhood physical features (both walkability and aesthetics) are associated with decreased physical activity level compared to better perceived neighbourhood features. This association was only observed in our adjusted models when IRT scoring was employed with the neighbourhood physical feature scales (walkability scale: odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02, 1.41; aesthetics scale: OR 1.32, 95% CI 1.09, 1.62), not when average scoring was used (walkability scale: OR 1.14, 95% CI 1.00, 1.30; aesthetics scale: OR 1.16, 95% CI 1.00, 1.36). CONCLUSION: In adults with arthritis, those reporting poorer walking and aesthetics features were found to have decreased physical activity levels compared to those reporting better features when IRT scores were used, but not when using average scores. This study may inform public health physical environmental interventions implemented to increase physical activity, especially since arthritis prevalence is expected to be close to 20% of the population in 2020. Based on NIH initiatives, future health research will utilize IRT scores. The differences found in this study may be a precursor for research on how past and future treatment effects may vary between these two types of measurement scores.

Physical therapy utilization by patients with acute low back pain.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to describe the demographic and clinical characteristics of a group of patients with acute low back pain (LBP), (2) to describe those patients who were being treated by physical therapists, and (3) to analyze their use of physical therapy services. SUBJECTS: The study sample consisted of 1,580 patients with acute LBP who were treated by 208 practitioners in North Carolina. The initial providers were primary care physicians, chiropractors, orthopedic surgeons, and primary care providers at a health maintenance organization. METHODS: A telephone interview was conducted after the initial office visit to assess demographics and medical history, health care services utilization, and functional status. Follow-up telephone interviews were also conducted 2, 4, 8, 12, and 24 weeks later. RESULTS: One hundred ninety-nine (12.6%) of the subjects reported that they saw a physical therapist either by any provider referral or by direct access. Therapeutic exercise was the most commonly reported treatment procedure. Post-high-school education, receipt of Workers' Compensation, prior physical therapy for LBP, LBP and pain below the knee in one or both legs, and a higher baseline Roland-Morris Questionnaire score were associated with being treated by physical therapists. CONCLUSION AND DISCUSSION: In this study, physical therapists were utilized in the treatment of patients with greater severity of LBP. The findings demonstrate the importance of controlling for baseline characteristics when comparing outcomes of LBP when treated by different types of providers.

Reliability of measuring active mandibular excursion using a new tool: the Mandibular Excursiometer.

Measurement tools improve the reliability and validity of measurement. The purpose of this study was to test the intrarater and interrater reliability of a new instrument, the Mandibular Excursiometer, for measuring mandibular excursion on the X and Y axis in the coronal plane during active opening. Two raters measured 12 volunteers. Four ratio, three nominal, and one ordinal scale measurements were analyzed using percent agreement. The Mandibular Excursiometer had high intrarater reliability for vertical opening (100%) and for the categorization of the presence or absence and direction of lateral deviation at the maximum point during opening (92-100%). Overall, moderate intrarater reliability existed for the quantity of lateral deviation at the maximum point during opening (66-83%), presence and direction of deflection (66-83%), presence of deviation or deflection during opening (66-83%), and in which third of opening the maximum point of lateral deviation occurred (66-83%). Moderate interrater reliability existed for vertical opening (75%) and for the classification of presence and direction of lateral deviation at the maximum point during opening (91%). All other measurements had low reliability. The Mandibular Excursiometer had higher intrarater and interrater reliability for measuring deviation and deflection during active mandibular opening than observation alone, based on a comparison with the literature. This measurement can assist in documenting progress while treating patients with TMJ disorders.